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Liu C, Filbey FM. Unlocking the age-old secrets of reward and substance use. Pharmacol Biochem Behav 2024; 239:173766. [PMID: 38604456 DOI: 10.1016/j.pbb.2024.173766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 03/25/2024] [Accepted: 04/08/2024] [Indexed: 04/13/2024]
Abstract
Although substance use is widespread across the lifespan from early adolescence to older adulthood, the prevalence of substance use disorder (SUD) differs between age groups. These age differences in SUD rates necessitate an investigation into how age moderates reward sensitivity, and consequently influences the risks and consequences related to substance use. This theoretical review integrates evidence from the literature to address the dynamic interplay between age and reward in the context of substance use. Overall, increasing evidence demonstrates that age moderates reward sensitivity and underlying reward system neurobiology. Reward sensitivity undergoes a non-linear trajectory across the lifespan. Low levels of reward sensitivity are associated with childhood and late adulthood. In contrast, high levels are associated with early to late adolescence, followed by a decline in the twenties. These fluctuations in reward sensitivity across the lifespan contribute to complex associations with substance use. This lends support to adolescence and young adulthood as vulnerable periods for the risk of subsequent SUD. More empirical research is needed to investigate reward sensitivity during SUD maintenance and recovery. Future research should also involve larger sample sizes and encompass a broader range of age groups, including older adults.
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Affiliation(s)
- Che Liu
- School of Behavioral and Brain Sciences, The University of Texas at Dallas, Dallas, TX 75235, United States of America.
| | - Francesca M Filbey
- School of Behavioral and Brain Sciences, The University of Texas at Dallas, Dallas, TX 75235, United States of America
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Dash GF, Bryan AD, Yang M, Chung T, Hudson KA, Feldstein Ewing SW. Adolescent: provider connectedness and STI risk reduction following a brief alcohol intervention: findings from a randomized controlled trial. Front Psychol 2023; 14:1171264. [PMID: 37546489 PMCID: PMC10399588 DOI: 10.3389/fpsyg.2023.1171264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 06/30/2023] [Indexed: 08/08/2023] Open
Abstract
Objective Given the frequent co-occurrence between alcohol use and sexual behavior among adolescents, alcohol interventions may play a role in helping prevent sexually transmitted infections (STIs) in this age group. Psychotherapy "common factors" are one potential active ingredient in intervention efficacy. Thus, the purpose of this study was to evaluate the influence of a critical common factor, adolescent: provider connectedness, on STI risk reduction at 3 months post-intervention. Methods Community-based youth (N = 168) were randomized to two 60-min individual sessions of either motivational interviewing (MI) or brief adolescent mindfulness (BAM). Logistic regressions predicted post-intervention positive STI from adolescent: provider connectedness, intervention condition, and their interaction. Path analytic models tested post-intervention hazardous drinking as a mediator of the association between adolescent: provider connectedness and reduction in STI risk at 3-month follow-up. Results Stronger adolescent: provider connectedness reduced risk of STI at 3 months post-intervention, with no differences by treatment condition. A mediational relationship between adolescent: provider connectedness and STI risk via hazardous drinking was not observed. Conclusion Psychotherapeutic common factors, including adolescent: provider connectedness, may be important in mitigating adolescent health risk in behavioral interventions, above and beyond intervention condition and beyond the target behavior of the intervention.
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Affiliation(s)
- Genevieve F. Dash
- Department of Psychological Sciences, University of Missouri, Columbia, MO, United States
| | - Angela D. Bryan
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO, United States
| | - Manshu Yang
- Department of Psychology, University of Rhode Island, Kingston, RI, United States
| | - Tammy Chung
- Department of Psychiatry, Institute for Health, Healthcare Policy and Aging Research, Rutgers, The State University of New Jersey, New Brunswick, NJ, United States
| | - Karen A. Hudson
- Department of Psychology, University of Rhode Island, Kingston, RI, United States
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3
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Feldstein Ewing SW, Karalunas SL, Kenyon EA, Yang M, Hudson KA, Filbey FM. Intersection between social inequality and emotion regulation on emerging adult cannabis use. DRUG AND ALCOHOL DEPENDENCE REPORTS 2022; 3:100050. [PMID: 35694031 PMCID: PMC9187048 DOI: 10.1016/j.dadr.2022.100050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 03/07/2022] [Accepted: 03/28/2022] [Indexed: 05/29/2023]
Abstract
Emerging adulthood (EA; ages 18-25) is characterized by socioemotional and neurodevelopmental challenges. Cannabis is a widely used substance among EAs, and hazardous use may increase risk for sustained use patterns and related health consequences. Research shows differential increases in hazardous use by objective as well as subjective measures of social inequality, with more concerning trajectories for youth with greater experiences of social inequality. Learning how to flexibly monitor and modify emotions in proactive ways (i.e., emotion regulation) is a central developmental task navigated during the EA window. Challenges to and with emotion regulation processes can contribute to the emergence of mental health symptoms during EA, including hazardous cannabis use. In this perspective, we highlight emotion dysregulation and social inequality as two critical factors that interact to either buffer against or exacerbate cannabis use during the EA period, noting critical gaps in the literature that merit additional research. We recommend novel methods and longitudinal designs to help clarify how dynamic cognition-emotion interplay predicts trajectories of negative emotional experiences and cannabis use in EA.
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Ewing SF, Bryan AD, Dash GF, Lovejoy TI, Borsari B, Schmiege SJ. Randomized controlled trial of motivational interviewing for alcohol and cannabis use within a predominantly Hispanic adolescent sample. Exp Clin Psychopharmacol 2022; 30:287-299. [PMID: 33749294 PMCID: PMC9113520 DOI: 10.1037/pha0000445] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Hispanic youth represent one of the fastest-growing minority groups. Yet, we know little about Hispanic adolescents' response to empirically-supported interventions for adolescent addiction, including motivational interviewing (MI). This randomized controlled trial (RCT) compared MI to an active educational treatment for adolescent alcohol and cannabis use (alcohol and cannabis education; ACE). Adolescents who regularly use substances (N = 448; n = 347 Hispanic; n = 101 non-Hispanic white; ages 13-18) were randomized to two 1-hr individual sessions of MI or ACE. We examined 6-month outcomes and mechanisms of change across Hispanic and non-Hispanic white youth. Treatment response was comparable across ethnicities (Hispanic vs. non-Hispanic white youth). Additionally, adolescents in the MI condition showed greater reductions in alcohol use compared to those in ACE, with support for motivation and self-efficacy as mechanisms of treatment response. Direct effects of MI on cannabis use were not observed; however, a significant indirect effect of motivation was observed for reductions in cannabis use. Data support the efficacy of MI in reducing adolescent alcohol use, through the vehicle of enhanced motivation and self-efficacy. While consistent treatment response was observed for adolescent alcohol use across ethnicities (Hispanic vs. non-Hispanic white), further exploration into potential underexplored mechanisms of Hispanic adolescents' treatment response is requisite to strengthening prevention and intervention programming for Hispanic adolescents' cannabis use. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
| | - Angela D. Bryan
- University of Colorado Boulder, Department of Psychology and Neuroscience, Boulder, CO
| | - Genevieve F. Dash
- University of Missouri, Department of Psychological Sciences, Columbia, MO
| | - Travis I. Lovejoy
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR
| | - Brian Borsari
- Mental Health Service, San Francisco VA Health Care System/ Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA
| | - Sarah J. Schmiege
- University of Colorado Anschutz Medical Campus, Department of Biostatistics and Informatics, Aurora, CO
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Mackiewicz Seghete KL, Filbey FM, Hudson KA, Hyun B, Feldstein Ewing SW. Time for a paradigm shift: The adolescent brain in addiction treatment. Neuroimage Clin 2022; 34:102960. [PMID: 35172248 PMCID: PMC8850747 DOI: 10.1016/j.nicl.2022.102960] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 12/29/2021] [Accepted: 02/06/2022] [Indexed: 11/02/2022]
Abstract
OBJECTIVE One route to improve adolescent addiction treatment outcomes is to use translational approaches to help identify developmental neuroscience mechanisms that undergird active treatment ingredients and advance adolescent behavior change. METHODS This sample included 163 adolescents (ages 15-19) randomized to motivational interviewing (MI) vs. brief adolescent mindfulness (BAM). Youth completed an fMRI paradigm assessing adolescent brain response to therapist language (complex reflection vs. mindful; complex reflection vs. confront; mindful vs. confront) at pre- (prior to the completion of the full intervention) and post-treatment (at 3-month follow-up) and behavioral measures at 3, 6 and 12 months. RESULTS Youth in both treatment groups showed significant problem drinking reductions at 3 and 6 months, but MI youth demonstrated significantly better treatment outcomes than BAM youth at 12 months. We observed several significant treatment group differences (MI > BAM) in neural response to therapist language, including at pre-treatment when examining complex reflection vs. mindful, and complex reflection vs. confront (e.g., superior temporal gyrus, lingual gyrus); and at post-treatment when examining mindful vs. confront (e.g., supplementary motor area; middle frontal gyrus). When collapsed across treatment groups (MI + BAM), we observed significant differences by time, with youth showing a pattern of brain change in response to complex reflection vs. mindful, and complex reflection vs. confront (e.g., precuneus; postcentral gyrus). There was no evidence of a significant group × time interaction. However, brain change in response to therapist language (complex reflection vs. confront) in regions such as middle frontal gyrus, was associated with reductions in problem drinking at 12 months. Yet, few treatment group differences were observed. CONCLUSIONS These data underscore the need to better understand therapist language and it's impact on the developing brain, in order to inform and aggregate the most impactful elements of addiction treatment for future treatment development for adolescents.
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Affiliation(s)
- Kristen L Mackiewicz Seghete
- Oregon Health & Science University, Department of Psychiatry, 3181 SW Sam Jackson Park Rd, M/C UHN80R1, Portland, OR 97239, USA.
| | - Francesca M Filbey
- Center for BrainHealth, School of Behavioral and Brain Sciences, The University of Texas at Dallas, 2200 West Mockingbird Lane, Dallas, TX 75235, USA.
| | - Karen A Hudson
- Departments of Psychology and Interdisciplinary Neuroscience, University of Rhode Island, 130 Flagg Rd, Kingston, RI 02881 USA.
| | - Benedict Hyun
- Departments of Psychology and Interdisciplinary Neuroscience, University of Rhode Island, 130 Flagg Rd, Kingston, RI 02881 USA.
| | - Sarah W Feldstein Ewing
- Departments of Psychology and Interdisciplinary Neuroscience, University of Rhode Island, 130 Flagg Rd, Kingston, RI 02881 USA.
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Lichenstein SD, Manco N, Cope LM, Egbo L, Garrison KA, Hardee J, Hillmer AT, Reeder K, Stern EF, Worhunsky P, Yip SW. Systematic review of structural and functional neuroimaging studies of cannabis use in adolescence and emerging adulthood: evidence from 90 studies and 9441 participants. Neuropsychopharmacology 2022; 47:1000-1028. [PMID: 34839363 PMCID: PMC8938408 DOI: 10.1038/s41386-021-01226-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 10/21/2021] [Accepted: 10/28/2021] [Indexed: 11/09/2022]
Abstract
Cannabis use peaks in adolescence, and adolescents may be more vulnerable to the neural effects of cannabis and cannabis-related harms due to ongoing brain development during this period. In light of ongoing cannabis policy changes, increased availability, reduced perceptions of harm, heightened interest in medicinal applications of cannabis, and drastic increases in cannabis potency, it is essential to establish an understanding of cannabis effects on the developing adolescent brain. This systematic review aims to: (1) synthesize extant literature on functional and structural neural alterations associated with cannabis use during adolescence and emerging adulthood; (2) identify gaps in the literature that critically impede our ability to accurately assess the effect of cannabis on adolescent brain function and development; and (3) provide recommendations for future research to bridge these gaps and elucidate the mechanisms underlying cannabis-related harms in adolescence and emerging adulthood, with the long-term goal of facilitating the development of improved prevention, early intervention, and treatment approaches targeting adolescent cannabis users (CU). Based on a systematic search of Medline and PsycInfo and other non-systematic sources, we identified 90 studies including 9441 adolescents and emerging adults (n = 3924 CU, n = 5517 non-CU), which provide preliminary evidence for functional and structural alterations in frontoparietal, frontolimbic, frontostriatal, and cerebellar regions among adolescent cannabis users. Larger, more rigorous studies are essential to reconcile divergent results, assess potential moderators of cannabis effects on the developing brain, disentangle risk factors for use from consequences of exposure, and elucidate the extent to which cannabis effects are reversible with abstinence. Guidelines for conducting this work are provided.
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Affiliation(s)
| | - Nick Manco
- Medical University of South Carolina, Charleston, SC, USA
| | - Lora M Cope
- Department of Psychiatry and Addiction Center, University of Michigan, Ann Arbor, MI, USA
| | - Leslie Egbo
- Neuroscience and Behavior Program, Wesleyan University, Middletown, CT, USA
| | | | - Jillian Hardee
- Department of Psychiatry and Addiction Center, University of Michigan, Ann Arbor, MI, USA
| | - Ansel T Hillmer
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- Department of Radiology & Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA
| | - Kristen Reeder
- Department of Internal Medicine, East Carolina University/Vidant Medical Center, Greenville, NC, USA
| | - Elisa F Stern
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO, USA
| | - Patrick Worhunsky
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Sarah W Yip
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- Child Study Center, Yale School of Medicine, New Haven, CT, USA
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7
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Randomized Controlled Trial of an Alcohol-related Sexual Risk Reduction Intervention with Adolescents: The Role of Neurocognitive Activation During Risky Decision-Making. AIDS Behav 2021; 25:265-275. [PMID: 33712986 DOI: 10.1007/s10461-021-03190-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2021] [Indexed: 10/21/2022]
Abstract
Justice-involved youth are at a higher risk of negative outcomes from sexual activity and alcohol use relative to their non-justice involved peers. In the current study, we tested the extent to which variability in neurocognitive response (i.e., activation in the right superior parietal lobule; rSPL) during a risky decision-making task moderated the success of a sexual risk reduction intervention. In a cluster randomized trial blocked by gender, justice-involved adolescents (N = 269) first completed a risky decision-making task during a magnetic resonance imaging (MRI) session, then were assigned to an information-only control (GINFO) or sexual risk reduction intervention incorporating alcohol risk reduction content (GPI + GMET) and then re-contacted every three months for one year. Youth in the GPI + GMET intervention reported less sexual risk behavior 12 months after intervention than those in the control. Although neurocognitive activation was associated with sexual risk behavior, it did not moderate intervention outcomes. This risk-reduction intervention appears to work equally well across a range of neurocognitive responses.
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Rømer Thomsen K, Thylstrup B, Kenyon EA, Lees R, Baandrup L, Feldstein Ewing SW, Freeman TP. Cannabinoids for the treatment of cannabis use disorder: New avenues for reaching and helping youth? Neurosci Biobehav Rev 2021; 132:169-180. [PMID: 34822876 DOI: 10.1016/j.neubiorev.2021.11.033] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 11/17/2021] [Accepted: 11/21/2021] [Indexed: 11/16/2022]
Abstract
Cannabis use peaks during adolescence and emerging adulthood, and cannabis use disorder (CUD) is associated with a wide range of adverse outcomes. This is particularly pertinent in youth, because the developing brain may be more vulnerable to adverse effects of frequent cannabis use. Combining evidence-based psychosocial interventions with safe and effective pharmacotherapy is a potential avenue to improve youth outcomes, but we lack approved CUD pharmacotherapies. Here, we review new potential avenues for helping youth with CUD, with a particular focus on cannabinoid-based treatments. Evidence from placebo-controlled RCTs suggests synthetic delta-9-tetrahydrocannabinol (THC) decreases withdrawal symptoms, but not cannabis use, in adults with daily cannabis use/CUD, while findings regarding formulations containing THC combined with cannabidiol (CBD) are mixed. Preliminary evidence from two placebo-controlled RCTs in adults with CUD suggests that both Fatty Acid Amide Hydrolase inhibitors and CBD can reduce cannabis use. However, larger trials are needed to strengthen the evidence. Findings from adults point to cannabinoid-based treatments as a potential strategy that should be examined in youth with CUD.
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Affiliation(s)
- Kristine Rømer Thomsen
- Centre for Alcohol and Drug Research, Department of Psychology and Behavioral Sciences, Aarhus University, Denmark.
| | - Birgitte Thylstrup
- Centre for Alcohol and Drug Research, Department of Psychology and Behavioral Sciences, Aarhus University, Denmark
| | - Emily A Kenyon
- Department of Psychology, University of Rhode Island, USA
| | - Rachel Lees
- Addiction and Mental Health Group (AIM), Department of Psychology, University of Bath, UK
| | - Lone Baandrup
- Mental Health Centre Copenhagen and Department of Clinical Medicine, University of Copenhagen, Denmark
| | - Sarah W Feldstein Ewing
- Centre for Alcohol and Drug Research, Department of Psychology and Behavioral Sciences, Aarhus University, Denmark; Department of Psychology, University of Rhode Island, USA
| | - Tom P Freeman
- Addiction and Mental Health Group (AIM), Department of Psychology, University of Bath, UK
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Sehl H, Terrett G, Greenwood LM, Kowalczyk M, Thomson H, Poudel G, Manning V, Lorenzetti V. Patterns of brain function associated with cannabis cue-reactivity in regular cannabis users: a systematic review of fMRI studies. Psychopharmacology (Berl) 2021; 238:2709-2728. [PMID: 34505940 PMCID: PMC8455486 DOI: 10.1007/s00213-021-05973-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 08/17/2021] [Indexed: 12/21/2022]
Abstract
RATIONALE Regular cannabis use (i.e. ≥ monthly) is highly prevalent, with past year use being reported by ~ 200 million people globally.High reactivity to cannabis cues is a key feature of regular cannabis use and has been ascribed to greater cannabis exposure and craving, but the underlying neurobiology is yet to be systematically integrated. OBJECTIVES We aim to systematically summarise the findings from fMRI studies which examined brain function in cannabis users while exposed to cannabis vs neutral stimuli during a cue-reactivity fMRI task. METHODS A systematic search of PsycINFO, PubMed and Scopus databases was pre-registered in PROSPERO (CRD42020171750) and conducted following PRISMA guidelines. Eighteen studies met inclusion/exclusion criteria. Samples comprised 918 participants (340 female) aged 16-38 years. Of these, 603 were regular cannabis users, and 315 were controls. RESULTS The literature consistently reported greater brain activity in cannabis users while exposed to cannabis vs neutral stimuli in three key brain areas: the striatum, the prefrontal (anterior cingulate, middle frontal) and the parietal cortex (posterior cingulate/precuneus) and additional brain regions (hippocampus, amygdala, thalamus, occipital cortex). Preliminary correlations emerged between cannabis craving and the function of partially overlapping regions (amygdala, striatum, orbitofrontal cortex ). CONCLUSIONS Exposure to cannabis-cues may elicit greater brain function and thus trigger cravings in regular cannabis users and thus trigger cannabis craving. Standardised and longitudinal assessments of cannabis use and related problems are required to profile with greater precision the neurobiology of cannabis cue-reactivity, and its role in predicting cravings and relapse.
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Affiliation(s)
- Hannah Sehl
- Neuroscience of Addiction and Mental Health Program, Healthy Brain and Mind Research Centre, School of Behavioural and Health Sciences, Faculty of Health Sciences, Australian Catholic University, Melbourne, Daniel Mannix building, 17 Young Street, Fitzroy, VIC 3065 Australia
| | - Gill Terrett
- Neuroscience of Addiction and Mental Health Program, Healthy Brain and Mind Research Centre, School of Behavioural and Health Sciences, Faculty of Health Sciences, Australian Catholic University, Melbourne, Daniel Mannix building, 17 Young Street, Fitzroy, VIC 3065 Australia
| | - Lisa-Marie Greenwood
- Research School of Psychology, Australian National University, Canberra, Australia ,The Australian Centre for Cannabinoid Clinical and Research Excellence (ACRE), New Lambton Heights, New South Wales Australia
| | - Magdalena Kowalczyk
- Neuroscience of Addiction and Mental Health Program, Healthy Brain and Mind Research Centre, School of Behavioural and Health Sciences, Faculty of Health Sciences, Australian Catholic University, Melbourne, Daniel Mannix building, 17 Young Street, Fitzroy, VIC 3065 Australia
| | - Hannah Thomson
- Neuroscience of Addiction and Mental Health Program, Healthy Brain and Mind Research Centre, School of Behavioural and Health Sciences, Faculty of Health Sciences, Australian Catholic University, Melbourne, Daniel Mannix building, 17 Young Street, Fitzroy, VIC 3065 Australia
| | - Govinda Poudel
- Mary Mackillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
| | - Victoria Manning
- Turning Point, Eastern Health, Monash University, Melbourne, Australia
| | - Valentina Lorenzetti
- Neuroscience of Addiction and Mental Health Program, Healthy Brain and Mind Research Centre, School of Behavioural and Health Sciences, Faculty of Health Sciences, Australian Catholic University, Melbourne, Daniel Mannix building, 17 Young Street, Fitzroy, VIC, 3065, Australia.
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Halladay J, Scherer J, MacKillop J, Woock R, Petker T, Linton V, Munn C. Brief interventions for cannabis use in emerging adults: A systematic review, meta-analysis, and evidence map. Drug Alcohol Depend 2019; 204:107565. [PMID: 31751868 DOI: 10.1016/j.drugalcdep.2019.107565] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 07/11/2019] [Accepted: 07/11/2019] [Indexed: 11/29/2022]
Abstract
PURPOSE This systematic review summarizes and critically appraises the existing literature on brief interventions (BIs) for cannabis use among emerging adults. METHODS Eligible BIs were operationalized as 1-2 sessions focused exclusively on cannabis use for samples with mean ages between 15 and 30. Outcomes related to cannabis use, other substance use, mental health, help-seeking, or functional status were included. Two independent reviewers screened a total of 3638 records, identifying 244 studies for full-text screening. In total, 32 BIs in 26 primary studies with 6318 participants were included. RESULTS Participants were typically not seeking treatment and using cannabis at least once a month. Most interventions were motivational, single sessions, and delivered in person. Few discussed concurrent psychiatric conditions. Pooling results at 1-3 months post-intervention, BIs compared to passive control slightly reduced symptoms of cannabis use disorder (SMD -0.14 [95% CI -0.26 to -0.01]) and increased the odds of abstinence (OR 1.73 [95% CI 1.13-2.66]). Other outcome results often favored BIs but were not significant. Results of studies comparing types of BIs (k = 8) or BIs to longer interventions (k = 1) are discussed narratively. Quality assessment suggested low to very low-quality evidence. CONCLUSIONS This review indicates that BIs targeting non-treatment seeking emerging adults result in significant reductions in symptoms of cannabis use disorder and an increased likelihood of cannabis abstinence, however evidence is of low quality.
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Affiliation(s)
- Jillian Halladay
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4S4, Canada.
| | - Justin Scherer
- Peter Boris Centre for Addictions Research, McMaster University/St. Joseph's Healthcare Hamilton, 100 West 5th St, Hamilton, Ontario, L8N 3K7, Canada.
| | - James MacKillop
- Peter Boris Centre for Addictions Research, McMaster University/St. Joseph's Healthcare Hamilton, 100 West 5th St, Hamilton, Ontario, L8N 3K7, Canada; Michael G. DeGroote Centre for Medicinal Cannabis Research, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4S4, Canada; Department of Psychiatry and Behavioural Neurosciences, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4S4, Canada.
| | - Rachel Woock
- Department of Health, Aging, and Society, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4S4, Canada.
| | - Tashia Petker
- Peter Boris Centre for Addictions Research, McMaster University/St. Joseph's Healthcare Hamilton, 100 West 5th St, Hamilton, Ontario, L8N 3K7, Canada.
| | - Vanessa Linton
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4S4, Canada.
| | - Catharine Munn
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4S4, Canada; Michael G. DeGroote Centre for Medicinal Cannabis Research, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4S4, Canada; Department of Psychiatry and Behavioural Neurosciences, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4S4, Canada.
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11
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Shollenbarger S, Thomas AM, Wade NE, Gruber SA, Tapert SF, Filbey FM, Lisdahl KM. Intrinsic Frontolimbic Connectivity and Mood Symptoms in Young Adult Cannabis Users. Front Public Health 2019; 7:311. [PMID: 31737591 PMCID: PMC6838025 DOI: 10.3389/fpubh.2019.00311] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 10/14/2019] [Indexed: 11/25/2022] Open
Abstract
Objective: The endocannbinoid system and cannabis exposure has been implicated in emotional processing. The current study examined whether regular cannabis users demonstrated abnormal intrinsic (a.k.a. resting state) frontolimbic connectivity compared to non-users. A secondary aim examined the relationship between cannabis group connectivity differences and self-reported mood and affect symptoms. Method: Participants included 79 cannabis-using and 80 non-using control emerging adults (ages of 18–30), balanced for gender, reading ability, and age. Standard multiple regressions were used to predict if cannabis group status was associated with frontolimbic connectivity after controlling for site, past month alcohol and nicotine use, and days of abstinence from cannabis. Results: After controlling for research site, past month alcohol and nicotine use, and days of abstinence from cannabis, cannabis users demonstrated significantly greater connectivity between left rACC and the following: right rACC (p = 0.001; corrected p = 0.05; f2 = 0.55), left amygdala (p = 0.03; corrected p = 0.47; f2 = 0.17), and left insula (p = 0.03; corrected p = 0.47; f2 = 0.16). Among cannabis users, greater bilateral rACC connectivity was significantly associated with greater subthreshold depressive symptoms (p = 0.02). Conclusions: Cannabis using young adults demonstrated greater connectivity within frontolimbic regions compared to controls. In cannabis users, greater bilateral rACC intrinsic connectivity was associated with greater levels of subthreshold depression symptoms. Current findings suggest that regular cannabis use during adolescence is associated with abnormal frontolimbic connectivity, especially in cognitive control and emotion regulation regions.
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Affiliation(s)
- Skyler Shollenbarger
- Psychology Department, University of Wisconsin-Milwaukee, Milwaukee, WI, United States
| | - Alicia M Thomas
- Psychology Department, University of Wisconsin-Milwaukee, Milwaukee, WI, United States
| | - Natasha E Wade
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States
| | - Staci A Gruber
- Imaging Center, McLean Hospital, Belmont, MA, United States.,Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Susan F Tapert
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States
| | - Francesca M Filbey
- Bert Moore Chair in BrainHealth, School of Behavioral and Brain Sciences, The University of Texas at Dallas, Dallas, TX, United States
| | - Krista M Lisdahl
- Psychology Department, University of Wisconsin-Milwaukee, Milwaukee, WI, United States
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12
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Hammond CJ, Allick A, Rahman N, Nanavati J. Structural and Functional Neural Targets of Addiction Treatment in Adolescents and Young Adults: A Systematic Review and Meta-Analysis. J Child Adolesc Psychopharmacol 2019; 29:498-507. [PMID: 31313938 PMCID: PMC6727475 DOI: 10.1089/cap.2019.0007] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Objective: Addictive disorders start during adolescence for most individuals, and developmental differences in brain maturation and response to treatments are present. Recent studies in adults have identified associations between addiction treatment response and regional and circuit specific brain dysfunction, suggesting candidate neural treatment targets. The purpose of this systematic review and meta-analysis was to qualitatively and quantitatively summarize findings from structural and functional neuroimaging studies that examine neural correlates of treatment response in adolescents and young adults with addictive disorders. Methods: A systematic review and meta-analysis of peer-reviewed studies was conducted following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Studies were selected if they included individuals aged 13-26 with a DSM-IV or DSM-5 (Diagnostic and Statistical Manual, Fourth and Fifth Edition) addictive disorder diagnosis, used neuroimaging, administered a treatment/intervention, and reported within- or between-subject contrasts in brain structure or activity across treatment/intervention and a control condition or brain-behavior correlations with treatment-outcome variables. Quantitative meta-analyses used an activation-likelihood estimation (ALE) approach. Results: Out of 3177 citations, 27 studies were included in the qualitative analysis. Qualitative analyses revealed anatomical, connectivity, and functional brain-behavior associations with response to addiction interventions across a broad array of cortical and subcortical brain regions and associated networks. Eighteen functional magnetic resonance imaging studies involving 354 participants and 88 brain foci were included in the ALE meta-analysis. Despite significant heterogeneity in study design and methods, six ALE activation clusters localized to the anterior cingulate cortex, inferior frontal gyrus, supramarginal gyrus, middle temporal gyrus, precuneus, and putamen showed consistent brain-behavior associations with treatment-outcome variables. Conclusions: Cortical and subcortical brain regions involved in cognition, emotion regulation, decision-making, reward, and self-reference are associated with treatment response in addicted youth. These results are consistent with findings in the adult literature and suggest overlapping neural treatment targets across developmental stages.
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Affiliation(s)
- Christopher J. Hammond
- Division of Child & Adolescent Psychiatry, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Department of Psychiatry & Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Address correspondence to: Christopher J. Hammond, MD, PhD, Division of Child & Adolescent Psychiatry, Johns Hopkins Bayview Medical Center, 5510 Nathan Shock Drive, Baltimore, MD 21224
| | - Aliyah Allick
- Division of Child & Adolescent Psychiatry, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Department of Psychiatry & Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Naisa Rahman
- Division of Child & Adolescent Psychiatry, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Department of Psychiatry & Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Julie Nanavati
- Welch Medical Library, Johns Hopkins University School of Medicine, Baltimore, Maryland
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13
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Elton A, Stanger C, James GA, Ryan-Pettes S, Budney A, Kilts CD. Intertemporal decision-making-related brain states predict adolescent drug abuse intervention responses. NEUROIMAGE-CLINICAL 2019; 24:101968. [PMID: 31404876 PMCID: PMC6699467 DOI: 10.1016/j.nicl.2019.101968] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 08/02/2019] [Accepted: 08/03/2019] [Indexed: 12/20/2022]
Abstract
Adolescent drug misuse represents a major risk factor for long-term drug use disorders. However, wide individual differences in responses to first-line behavioral therapies targeting adolescent drug misuse limit critical early intervention. Identifying the neural signatures of those adolescents most likely to respond to an intervention would potentially guide personalized strategies for reducing drug misuse. Prior to a 14-week evidence-based intervention involving combinations of contingency management, motivational enhancement, and cognitive behavioral therapy, thirty adolescent alcohol and/or cannabis users underwent fMRI while performing a reward delay discounting (DD) task tapping an addiction-related cognition. Intervention responses were longitudinally characterized by both urinalysis and self-report measures of the percentage of days used during treatment and in post-treatment follow-up. Group independent component analysis (ICA) of task fMRI data identified neural processing networks related to DD task performance. Separate measures of wholesale recruitment during immediate reward choices and within-network functional connectivity among selective networks significantly predicted intervention-related changes in drug misuse frequency. Specifically, heightened pre-intervention engagement of a temporal lobe "reward motivation" network for impulsive choices on the DD task predicted poorer intervention outcomes, while modes of functional connectivity within the reward motivation network, a prospection network, and a posterior insula network demonstrated robust associations with intervention outcomes. Finally, the pre-intervention functional organization of the prospection network also predicted post-intervention drug use behaviors for up to 6 months of follow-up. Multiple functional variations in the neural processing networks supporting preference for immediate and future rewards signal individual differences in readiness to benefit from an effective behavioral therapy for reducing adolescent drug misuse. The implications for efforts to boost therapy responses are discussed.
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Affiliation(s)
- Amanda Elton
- University of North Carolina at Chapel Hill, USA.
| | | | | | | | - Alan Budney
- Geisel School of Medicine at Dartmouth College, USA
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14
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Grodin EN, Lim AC, MacKillop J, Karno MP, Ray LA. An Examination of Motivation to Change and Neural Alcohol Cue Reactivity Following a Brief Intervention. Front Psychiatry 2019; 10:408. [PMID: 31244697 PMCID: PMC6580427 DOI: 10.3389/fpsyt.2019.00408] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 05/22/2019] [Indexed: 12/15/2022] Open
Abstract
Background: Brief interventions represent a promising psychological intervention targeting individuals with heavy alcohol use. Motivation to change represents an individual's openness to engage in a behavior change strategy and is thought to be a crucial component of brief interventions. Neuroimaging techniques provide a translational tool to investigate the neurobiological mechanisms underlying potential mediators of treatment response, including motivation to change. Therefore, this study aimed to examine the effect of a brief intervention on motivation to change drinking behavior and neural alcohol taste cue reactivity. Methods: Non-treatment-seeking heavy drinkers were randomized to receive a brief drinking intervention (n = 22) or an attention-matched control (n = 24). Three indices of motivation to change were assessed at baseline and after the intervention or control session: importance, confidence, and readiness. Immediately following the intervention or control session, participants also underwent an functional magnetic resonance imaging (fMRI) during which they completed an alcohol taste cues paradigm. Results: There was a significant effect of the brief intervention on increasing ratings of importance of changing drinking behavior, but not on ratings of confidence or readiness to change. Ratings of importance after the intervention or control session were associated with neural alcohol taste cue reactivity, but notably, this effect was only significant for participants who received the intervention. Individuals in the intervention condition showed a positive association between ratings of importance and activation in the precuneus, posterior cingulate, and insula. Conclusions: The brief drinking intervention was successful at improving one dimension of motivation to change among non-treatment-seeking heavy drinkers. The brief intervention moderated the relationship between ratings of importance and brain activation in circuitry associated with interoceptive awareness and self-reflection. Together, findings represent an initial step toward understanding the neurobiological mechanisms through which a brief intervention may improve motivation to change.
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Affiliation(s)
- Erica N. Grodin
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States
- Department of Psychiatry and Biobehavioral Sciences, UCLA School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Aaron C. Lim
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States
| | - James MacKillop
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Mitchell P. Karno
- Department of Psychiatry and Biobehavioral Sciences, UCLA School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Lara A. Ray
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States
- Department of Psychiatry and Biobehavioral Sciences, UCLA School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
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15
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Silvers JA, Squeglia LM, Rømer Thomsen K, Hudson KA, Feldstein Ewing SW. Hunting for What Works: Adolescents in Addiction Treatment. Alcohol Clin Exp Res 2019; 43:578-592. [PMID: 30779445 PMCID: PMC6443447 DOI: 10.1111/acer.13984] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 02/08/2019] [Indexed: 12/11/2022]
Abstract
Although adolescents are developmentally distinct from adults, they often receive addiction treatment based on adult models. This is problematic because adolescents face significantly different conditions in addiction treatment, including distinct basic biological and neurodevelopmental stages, unique sociodevelopmental concerns, distinctive addiction trajectories, and, in turn, disparate treatment goals and outcomes. In sum, it can be difficult for even savvy clinicians to know how to approach addiction treatment with this important age group. In an effort to help clinicians and researchers consider substance use via a neurodevelopmental lens, we approached this review with 4 goals: (i) characterize the prevalence, and related health and safety implications of substance use within this age group; (ii) identify the nature of the adolescent brain, including characteristic features of this phase of neurodevelopment relevant to adolescent substance use treatment; (iii) provide an overview of current adolescent addiction interventions and avenues to improve clinical treatment and clinical research efforts for adolescents; and (iv) examine the intersection between the nature of the developing brain and adolescent substance use, and utilize that information to inform alternative routes and directions for substance use treatment in this critical age group. This review concludes by offering a novel neurodevelopmental model and framework to examine substance use interventions, along with a series of recommendations to optimize adolescent substance use treatment and clinical research.
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Affiliation(s)
- Jennifer A. Silvers
- University of California, Los Angeles, Department of Psychology, 1285 Franz Hall, Box 951563, Los Angeles, CA 90095-1563, USA;
| | - Lindsay M. Squeglia
- Medical University of South Carolina, Department of Psychiatry and Behavioral Sciences, 67 President St., MSC 861, Charleston, SC 29425, USA;
| | - Kristine Rømer Thomsen
- Aarhus University, Department of Psychology and Behavioral Sciences, Center for Alcohol and Drug Research, Bartholins Allé 10, 8000 Aarhus C, Denmark;
| | - Karen A. Hudson
- Oregon Health & Science University, Department of Child & Adolescent Psychiatry, 3181 SW Sam Jackson Park Rd, M/C UHN80R1, Portland, OR 97239, USA,
| | - Sarah W. Feldstein Ewing
- Oregon Health & Science University, Department of Child & Adolescent Psychiatry, 3181 SW Sam Jackson Park Rd, M/C UHN80R1, Portland, OR 97239, USA,
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16
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Feldstein Ewing SW, Chung T. Precuneus: A Key on the Road to Translation. Alcohol Res 2019; 43:1063-1065. [PMID: 30892706 DOI: 10.1111/acer.14026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 03/14/2019] [Indexed: 01/30/2023] Open
Affiliation(s)
- Sarah W Feldstein Ewing
- Department of Child and Adolescent Psychiatry , Oregon Health and Science University, Portland, Oregon
| | - Tammy Chung
- Department of Psychiatry , Western Psychiatric Institute and Clinic, University of Pittsburgh, Pittsburgh, Pennsylvania
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17
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Grodin EN, Ray LA, MacKillop J, Lim AC, Karno MP. Elucidating the Effect of a Brief Drinking Intervention Using Neuroimaging: A Preliminary Study. Alcohol Clin Exp Res 2019; 43:367-377. [PMID: 30556913 DOI: 10.1111/acer.13941] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 12/09/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND Brief interventions have empirical support for acutely reducing alcohol use among non-treatment-seeking heavy drinkers. Neuroimaging techniques allow for the examination of the neurobiological effect of behavioral interventions, probing brain systems putatively involved in clinical response to treatment. Few studies have prospectively evaluated whether psychosocial interventions attenuate neural cue reactivity that in turn reduces drinking in the same population. This study aimed to examine the effect of a brief intervention on drinking outcomes, neural alcohol cue reactivity, and the ability of neural alcohol cue reactivity to prospectively predict drinking outcomes. METHODS Non-treatment-seeking heavy drinking participants were randomized to receive a brief interview intervention (n = 22) or an attention-matched control (n = 24). Immediately following the intervention or control, participants underwent a functional magnetic resonance imaging scan comprised of the alcohol taste cues paradigm. Four weeks after the intervention (or control), participants completed a follow-up visit to report on their past-month drinking. Baseline and follow-up percent heavy drinking days (PHDD) were calculated for each participant. RESULTS There was no significant effect of the brief intervention on PHDD at follow-up or on modulating neural activation to alcohol relative to water taste cues. There was a significant association between neural response to alcohol taste cues and PHDD across groups (Z > 2.3, p < 0.05), such that individuals who had greater neural reactivity to alcohol taste cues in the precuneus and prefrontal cortex (PFC) had fewer PHDD at follow-up. CONCLUSIONS This study did not find an effect of the brief intervention on alcohol use in this sample, and the intervention was not associated with differential neural alcohol cue reactivity. Nevertheless, greater activation of the precuneus and PFC during alcohol cue exposure predicted less alcohol use prospectively suggesting that these neural substrates subserve the effects of alcohol cues on drinking behavior.
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Affiliation(s)
- Erica N Grodin
- Department of Psychology, University of California, Los Angeles, Los Angeles, California.,Department of Psychiatry and Biobehavioral Sciences, UCLA School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Lara A Ray
- Department of Psychology, University of California, Los Angeles, Los Angeles, California.,Department of Psychiatry and Biobehavioral Sciences, UCLA School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - James MacKillop
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Aaron C Lim
- Department of Psychology, University of California, Los Angeles, Los Angeles, California
| | - Mitchell P Karno
- Department of Psychiatry and Biobehavioral Sciences, UCLA School of Medicine, University of California, Los Angeles, Los Angeles, California
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18
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Magill M, Hallgren KA. Mechanisms of behavior change in motivational interviewing: do we understand how MI works? Curr Opin Psychol 2018; 30:1-5. [PMID: 30677627 DOI: 10.1016/j.copsyc.2018.12.010] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Revised: 12/05/2018] [Accepted: 12/12/2018] [Indexed: 11/18/2022]
Abstract
This work provides an overview of Motivational Interviewing (MI) theory, the nature of the evidence for its mechanisms of action, and considers future directions. There are three hypotheses purported to explain how MI works: The Technical Hypothesis, the Relational Hypothesis, and the Conflict Resolution Hypothesis. In contrast to the latter two hypotheses, the Technical Hypothesis has received the most empirical attention in the MI process literature. Research shows that clinician technical skills in MI are well-defined, they relate to the intended client mechanisms (i.e. change talk and sustain talk), but the evidence supporting client mechanisms as predictors of subsequent changes to behavior is less conclusive. Future research and clinical implications are briefly considered.
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Affiliation(s)
- Molly Magill
- Brown University, Center for Alcohol and Addiction Studies, Providence, RI 02912, United States.
| | - Kevin A Hallgren
- University of Washington, Department of Psychiatry and Behavioral Sciences, Seattle, WA 98195, United States
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19
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Feldstein Ewing SW, Claus ED, Hudson KA, Filbey FM, Yakes Jimenez E, Lisdahl KM, Kong AS. Overweight adolescents' brain response to sweetened beverages mirrors addiction pathways. Brain Imaging Behav 2018; 11:925-935. [PMID: 27392791 DOI: 10.1007/s11682-016-9564-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Many adolescents struggle with overweight/obesity, which exponentially increases in the transition to adulthood. Overweight/obesity places youth at risk for serious health conditions, including type 2 diabetes. In adults, neural substrates implicated in addiction (e.g., orbitofrontal cortex (OFC), striatum, amygdala, and ventral tegmental area) have been found to be relevant to risk for overweight/obesity. In this study, we examined three hypotheses to disentangle the potential overlap between addiction and overweight/obesity processing by examining (1) brain response to high vs. low calorie beverages, (2) the strength of correspondence between biometrics, including body mass index (BMI) and insulin resistance, and brain response and (3) the relationship between a measure of food addiction and brain response using an established fMRI gustatory cue exposure task with a sample of overweight/obese youth (M age = 16.46; M BMI = 33.1). Greater BOLD response was observed across the OFC, inferior frontal gyrus (IFG), nucleus accumbens, right amygdala, and additional frontoparietal and temporal regions in neural processing of high vs. low calorie beverages. Further, BMI scores positively correlated with BOLD activation in the high calorie > low calorie contrast in the right postcentral gyrus and central operculum. Insulin resistance positively correlated with BOLD activation across the bilateral middle/superior temporal gyrus, left OFC, and superior parietal lobe. No relationships were observed between measures of food addiction and brain response. These findings support the activation of parallel addiction-related neural pathways in adolescents' high calorie processing, while also suggesting the importance of refining conceptual and neurocognitive models to fit this developmental period.
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Affiliation(s)
- Sarah W Feldstein Ewing
- Oregon Health & Science University, Mail code: DC7P, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239-3098, USA.
| | - Eric D Claus
- The Mind Research Network, 1101 Yale Blvd. NE, Albuquerque, NM, 87106, USA
| | - Karen A Hudson
- Oregon Health & Science University, Mail code: DC7P, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239-3098, USA
| | - Francesca M Filbey
- Center for BrainHealth, School of Behavioral and Brain Sciences, The University of Texas at Dallas, 2200 West Mockingbird Lane, Dallas, TX, 75235, USA
| | - Elizabeth Yakes Jimenez
- Departments of Individual, Family and Community Education and Family and Community Medicine, University of New Mexico, 1 University of New Mexico, Albuquerque, NM, 87112, USA
| | - Krista M Lisdahl
- Department of Psychology, University of Wisconsin-Milwaukee, Milwaukee, WI, 53211, USA
| | - Alberta S Kong
- Department of Pediatrics, Division of Adolescent Medicine and Department of Family and Community Medicine, University of New Mexico, MSC 10 5590, 1 University of New Mexico, Albuquerque, NM, 87131, USA
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20
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Jones SA, Morales AM, Lavine JB, Nagel BJ. Convergent neurobiological predictors of emergent psychopathology during adolescence. Birth Defects Res 2018; 109:1613-1622. [PMID: 29251844 DOI: 10.1002/bdr2.1176] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 11/02/2017] [Indexed: 01/03/2023]
Abstract
The adolescent brain undergoes significant structural and functional development. Through the use of magnetic resonance imaging in adolescents, it has been demonstrated that the prefrontal cortex, pertinent for executive control, demonstrates protracted development compared to limbic structures, active during emotion and reward processing. This asynchronous development creates a sensitive window during adolescence, in which many psychopathological disorders (i.e., mental health and substance use) emerge. This review outlines longitudinal studies that use magnetic resonance imaging to identify neurobiological predictors of emergent psychopathology (depression, anxiety, and substance use), during adolescence. Studies identifying neurobiological markers that predict onset and escalation of these disorders, as well as those that predict successful treatment outcomes are explored. An emphasis is placed on frontolimbic brain structures, a convergent neurobiological target for both emergent mental health issues and emergent substance use. The literature reviewed herein suggests that reduced volume and cortical thickness in frontolimbic regions, as well as reduced functional activation (particularly during task involving reward or emotional stimuli) in these regions, may serve as a neurobiological predictors of emergent psychopathology in adolescence. This knowledge is crucial, as it may be used to develop neurobiologically targeted prevention and intervention strategies for youth who are at-risk for developing these psychopathologies.
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Affiliation(s)
- Scott A Jones
- Department of Behavioral Neuroscience, Oregon Health & Science University, Portland, Oregon
| | - Angelica M Morales
- Department of Behavioral Neuroscience, Oregon Health & Science University, Portland, Oregon
| | - Jessye B Lavine
- Department of Psychiatry, Oregon Health & Science University, Portland, Oregon
| | - Bonnie J Nagel
- Department of Behavioral Neuroscience, Oregon Health & Science University, Portland, Oregon.,Department of Psychiatry, Oregon Health & Science University, Portland, Oregon
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21
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Yip SW, Potenza MN. Application of Research Domain Criteria to childhood and adolescent impulsive and addictive disorders: Implications for treatment. Clin Psychol Rev 2018; 64:41-56. [PMID: 27876165 PMCID: PMC5423866 DOI: 10.1016/j.cpr.2016.11.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Revised: 03/18/2016] [Accepted: 11/07/2016] [Indexed: 12/30/2022]
Abstract
The Research Domain Criteria (RDoC) initiative provides a large-scale, dimensional framework for the integration of research findings across traditional diagnoses, with the long-term aim of improving existing psychiatric treatments. A neurodevelopmental perspective is essential to this endeavor. However, few papers synthesizing research findings across childhood and adolescent disorders exist. Here, we discuss how the RDoC framework may be applied to the study of childhood and adolescent impulsive and addictive disorders in order to improve neurodevelopmental understanding and to enhance treatment development. Given the large scope of RDoC, we focus on a single construct highly relevant to addictive and impulsive disorders - initial responsiveness to reward attainment. Findings from genetic, molecular, neuroimaging and other translational research methodologies are highlighted.
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Affiliation(s)
- Sarah W Yip
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States; The National Center on Addiction and Substance Abuse, Yale University School of Medicine, New Haven, CT, United States
| | - Marc N Potenza
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States; The National Center on Addiction and Substance Abuse, Yale University School of Medicine, New Haven, CT, United States; Child Study Center, Yale University School of Medicine, New Haven, CT, United States; Department of Neurobiology, Yale University School of Medicine, New Haven, CT, United States.
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22
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Walton MA, Ngo QM, Chermack ST, Blow FC, Ehrlich PF, Bonar EE, Cunningham RM. Understanding Mechanisms of Change for Brief Alcohol Interventions Among Youth: Examination of Within-Session Interactions. J Stud Alcohol Drugs 2018; 78:725-734. [PMID: 28930060 DOI: 10.15288/jsad.2017.78.725] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Alcohol brief interventions (BIs) for youth are efficacious, but effect sizes found have been modest. This article presents secondary data analyses from a randomized controlled trial of motivational interviewing-based (MI) alcohol BIs among youth in an emergency department, examining within-session predictors of alcohol outcomes at 3 months among those receiving BIs. METHOD Risky drinkers (ages 14-20) received either a computer BI (n = 277) or therapist BI (n = 278). Within-session measures were obtained via computer metrics (therapist and computer BIs) and coding of audiotapes (therapist BI only). Parallel structural equation models examined direct and indirect effects of BI components on 3-month alcohol consumption and consequences, with posttest precursors of behavior change (e.g., importance, readiness, and intentions) as potential mediators. Components examined included reasons to avoid or reduce drinking, strengths, strategies for change, benefits of change, and leisure activities (computer BI only), and MI global ratings and MI-adherent behaviors (therapist BI only). RESULTS For both BIs, greater number of strategies directly predicted greater posttest scores, with posttest scores mediating the relationship between strategies and alcohol consumption at 3 months. Greater number of strengths directly predicted fewer alcohol-related consequences at 3 months for both BIs; however, strengths also indirectly predicted greater consumption, mediated by posttest scores. Greater number of reasons to avoid or reduce drinking directly predicted greater alcohol consumption for the therapist BI only. CONCLUSIONS These findings suggest ways to optimize the content and efficacy of alcohol BIs. Reviews of strategies such as refusal skills, protective behavioral strategies, and coping with negative affect may be particularly salient for reducing alcohol misuse.
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Affiliation(s)
- Maureen A Walton
- Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, Michigan.,Injury Center, University of Michigan, Ann Arbor, Michigan
| | - Quyen M Ngo
- Injury Center, University of Michigan, Ann Arbor, Michigan.,Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan.,Institute on Women and Gender Studies, University of Michigan, Ann Arbor, Michigan
| | - Stephen T Chermack
- Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, Michigan.,Mental Health Service, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - Frederic C Blow
- Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, Michigan.,Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan.,Mental Health Innovation, Services, and Outcomes Section, Department of Psychiatry, University of Michigan, Ann Arbor, Michigan
| | - Peter F Ehrlich
- Injury Center, University of Michigan, Ann Arbor, Michigan.,Section of Pediatric Surgery, Department of Surgery, C.S. Mott Children's Hospital, University of Michigan Health System, Ann Arbor, Michigan
| | - Erin E Bonar
- Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, Michigan
| | - Rebecca M Cunningham
- Injury Center, University of Michigan, Ann Arbor, Michigan.,Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan.,School of Public Health, University of Michigan, Ann Arbor, Michigan
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23
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Forster SE, Dickey MW, Forman SD. Regional cerebral blood flow predictors of relapse and resilience in substance use recovery: A coordinate-based meta-analysis of human neuroimaging studies. Drug Alcohol Depend 2018; 185:93-105. [PMID: 29428325 DOI: 10.1016/j.drugalcdep.2017.12.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 11/29/2017] [Accepted: 12/01/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND Predicting relapse vulnerability can inform level-of-care and personalized substance use treatment. Few reliable predictors of relapse risk have been identified from traditional clinical, psychosocial, and demographic variables. However, recent neuroimaging findings highlight the potential prognostic import of brain-based signals, indexing the degree to which neural systems have been perturbed by addiction. These proposed "neuromarkers" forecast the likelihood, severity, and timing of relapse but the reliability and generalizability of such effects remains to be established. METHODS Activation likelihood estimation was used to conduct a preliminary quantitative, coordinate-based meta-analysis of the addiction neuroprediction literature; specifically, studies wherein baseline measures of regional cerebral blood flow were prospectively associated with substance use treatment outcomes. Consensus patterns of activation associated with relapse vulnerability (greater activation predicts poorer outcomes) versus resilience (greater activation predicts improved outcomes) were specifically investigated. RESULTS Twenty-four eligible studies yielded 134 foci, representing 923 subjects. Consensus activation was identified in right putamen and claustrum (p < .05, cluster-corrected) in relation to positive and negative treatment outcomes - likely reflecting variability in measurement context (e.g., task, sample characteristics) across datasets. A single cluster in rostral-ventral anterior cingulate cortex (rACC) was associated with relapse resilience, specifically (p < .05, cluster-corrected); no significant vulnerability-related clusters were identified. CONCLUSIONS Right putamen activation has been associated with relapse vulnerability and resilience, while increased baseline rACC activation has been consistently associated with improved treatment outcomes. Methodological heterogeneity within the existing literature, however, limits firm conclusions and future work will be necessary to confirm and clarify these results.
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Affiliation(s)
- Sarah E Forster
- VA Pittsburgh Healthcare System, United States; University of Pittsburgh, Department of Psychiatry, United States.
| | - Michael Walsh Dickey
- VA Pittsburgh Healthcare System, United States; University of Pittsburgh, Department of Psychology, United States; University of Pittsburgh, Department of Communication Science and Disorders, United States
| | - Steven D Forman
- VA Pittsburgh Healthcare System, United States; University of Pittsburgh, Department of Psychiatry, United States
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24
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Psychometric assessment of the marijuana adolescent problem inventory. Addict Behav 2018; 79:113-119. [PMID: 29288984 DOI: 10.1016/j.addbeh.2017.12.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2017] [Accepted: 12/12/2017] [Indexed: 11/21/2022]
Abstract
Cannabis is one of the most commonly used psychoactive substances among adolescents in the United States. Adolescent cannabis use has multiple consequences including academic, health, and psychiatric problems. The Marijuana Adolescent Problem Inventory (MAPI) is a 23-item scale adapted from the Rutgers Alcohol Problem Index and used in the current literature to assess cannabis use problem severity. Psychometric testing for the MAPI has yet to be reported. The current investigation assessed the psychometric characteristics of the MAPI with cannabis-using adolescents (n=727) from school and outpatient settings who enrolled in five separate randomized clinical trials focused on treatment of substance use. Findings suggested that the MAPI is internally consistent and reliable. Factor structure analyses suggested that the MAPI measures one latent construct, with no differences in factor structure between the outpatient and school settings, supporting a one-factor model. External validity of the MAPI was also demonstrated as evidenced by significant relations with concurrent diagnosis of cannabis dependence and abuse, longitudinal frequency of cannabis use, and mean times used per day. Overall, this initial test of the psychometric characteristics of the MAPI suggests that it can be considered a reliable and valid measure of problems associated with cannabis use among adolescents. Future work is now needed to replicate these findings by testing the psychometric properties of the MAPI in more diverse samples and developing a short version to be used as a brief assessment tool.
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Houck JM, Feldstein Ewing SW. Working memory capacity and addiction treatment outcomes in adolescents. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2017; 44:185-192. [PMID: 28726525 DOI: 10.1080/00952990.2017.1344680] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Brief addiction treatments including motivational interviewing (MI) have shown promise with adolescents, but the factors that influence treatment efficacy in this population remain unknown. One candidate is working memory, the ability to hold a fact or thought in mind. This is relevant, as in therapy, a client must maintain and manipulate ideas while working with a clinician. Working memory depends upon brain structures and functions that change markedly during neurodevelopment and that can be negatively impacted by substance use. OBJECTIVES In a secondary analysis of data from a clinical trial for adolescent substance use comparing alcohol/marijuana education and MI, we evaluated the relationship between working memory and three-month treatment-outcomes with the hypothesis that the relationship between intervention conditions and outcome would be moderated by working memory. METHODS With a diverse sample of adolescents currently using alcohol and/or marijuana (N = 153, 64.7% male, 70.6% Hispanic), we examined the relationship between baseline measures of working memory and alcohol and cannabis-related problem scores measured at the three-month follow-up. RESULTS The results showed that lower working memory scores were associated with poorer treatment response only for alcohol use, and only within the education group. No relationship was found between working memory and treatment outcomes in the MI group. CONCLUSION The results suggest that issues with working memory capacity may interfere with adolescents' ability to process and implement didactic alcohol and marijuana content in standard education interventions. These results also suggest that MI can be implemented equally effectively across the range of working memory functioning in youth.
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Affiliation(s)
- Jon M Houck
- a Center on Alcoholism, Substance Abuse, and Addictions , University of New Mexico , Albuquerque , NM , USA
| | - Sarah W Feldstein Ewing
- b Department of Child & Adolescent Psychiatry , Oregon Health & Science University , Portland , OR , USA
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Caouette JD, Feldstein Ewing SW. Four Mechanistic Models of Peer Influence on Adolescent Cannabis Use. CURRENT ADDICTION REPORTS 2017; 4:90-99. [PMID: 29104847 DOI: 10.1007/s40429-017-0144-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Purpose of review Most adolescents begin exploring cannabis in peer contexts, but the neural mechanisms that underlie peer influence on adolescent cannabis use are still unknown. This theoretical overview elucidates the intersecting roles of neural function and peer factors in cannabis use in adolescents. Recent findings Novel paradigms using functional magnetic resonance imaging (fMRI) in adolescents have identified distinct neural mechanisms of risk decision-making and incentive processing in peer contexts, centered on reward-motivation and affect regulatory neural networks; these findings inform a theoretical model of peer-driven cannabis use decisions in adolescents. Summary We propose four "mechanistic profiles" of social facilitation of cannabis use in adolescents: (1) peer influence as the primary driver of use; (2) cannabis exploration as the primary driver, which may be enhanced in peer contexts; (3) social anxiety; and (4) negative peer experiences. Identification of "neural targets" involved in motivating cannabis use may inform clinicians about which treatment strategies work best in adolescents with cannabis use problems, and via which social and neurocognitive processes.
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Affiliation(s)
- Justin D Caouette
- Oregon Health & Science University, Department of Psychiatry, 3314 SW US Veteran's Hospital Road, M/C DC7P, Portland, OR 97239, USA
| | - Sarah W Feldstein Ewing
- Oregon Health & Science University, Department of Psychiatry, 3314 SW US Veteran's Hospital Road, M/C DC7P, Portland, OR 97239, USA
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Vergara D, Bidwell LC, Gaudino R, Torres A, Du G, Ruthenburg TC, deCesare K, Land DP, Hutchison KE, Kane NC. Compromised External Validity: Federally Produced Cannabis Does Not Reflect Legal Markets. Sci Rep 2017; 7:46528. [PMID: 28422145 PMCID: PMC5395929 DOI: 10.1038/srep46528] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2016] [Accepted: 03/22/2017] [Indexed: 01/02/2023] Open
Abstract
As the most widely used illicit drug worldwide, and as a source of numerous under-studied pharmacologically-active compounds, a precise understanding of variability in psychological and physiological effects of Cannabis varieties is essential. The National Institute on Drug Abuse (NIDA) is designated as the sole legal producer of Cannabis for use in US research studies. We sought to compare the chemical profiles of Cannabis varieties that are available to consumers in states that have state-legalized use versus what is available to researchers interested in studying the plant and its effects. Our results demonstrate that the federally-produced Cannabis has significantly less variety and lower concentrations of cannabinoids than are observed in state-legal U.S. dispensaries. Most dramatically, NIDA’s varieties contain only 27% of the THC levels and as much as 11–23 times the Cannabinol (CBN) content compared to what is available in the state-legal markets. Research restricted to using the current range of federally-produced Cannabis thus may yield limited insights into the chemical, biological and pharmacological properties, and medical potential of material that is available in the state markets. Investigation is urgently needed on the full diversity of Cannabis chemotypes known to be available to the public.
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Affiliation(s)
- Daniela Vergara
- University of Colorado Boulder, Department of Ecology and Evolutionary Biology, Boulder, CO 80309-0334, USA
| | - L Cinnamon Bidwell
- University of Colorado Boulder, Institute of Cognitive Science, Boulder, CO 80309-0334, USA
| | - Reggie Gaudino
- Steep Hill Labs Inc. 1005 Parker Street, Berkeley, CA 94710, USA
| | - Anthony Torres
- Steep Hill Labs Inc. 1005 Parker Street, Berkeley, CA 94710, USA
| | - Gary Du
- Steep Hill Labs Inc. 1005 Parker Street, Berkeley, CA 94710, USA
| | | | - Kymron deCesare
- Steep Hill Labs Inc. 1005 Parker Street, Berkeley, CA 94710, USA
| | - Donald P Land
- Steep Hill Labs Inc. 1005 Parker Street, Berkeley, CA 94710, USA
| | - Kent E Hutchison
- University of Colorado Boulder, Department of Psychology and Neuroscience, Boulder, CO 80309-0334, USA
| | - Nolan C Kane
- University of Colorado Boulder, Department of Ecology and Evolutionary Biology, Boulder, CO 80309-0334, USA
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Interventions aimed at automatic processes in addiction: considering necessary conditions for efficacy. Curr Opin Behav Sci 2017. [DOI: 10.1016/j.cobeha.2016.08.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Feldstein Ewing SW, Chung T, Caouette JD, Ketcherside A, Hudson KA, Filbey FM. Orbitofrontal cortex connectivity as a mechanism of adolescent behavior change. Neuroimage 2016; 151:14-23. [PMID: 28039093 DOI: 10.1016/j.neuroimage.2016.12.076] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 12/23/2016] [Accepted: 12/27/2016] [Indexed: 01/08/2023] Open
Abstract
An increasing number of studies have implicated the role of network functional connectivity in addiction. Yet, none have examined functional connectivity as a potential mechanism of adolescent behavior change. We examined the underlying neural mechanism of a promising treatment for adolescents, motivational interviewing (MI). We began by employing psychophysiological interaction (PPI) to evaluate network response in a sample of adolescent cannabis users (N=30). Next, we examined correlations between network connectivity and clinical metrics of treatment outcome. PPI analyses seeded on the orbitofrontal cortex (OFC) showed significant increases in functional connectivity across the inferior frontal gyrus (IFG), precentral gyrus, anterior and posterior cingulate gyrus, supplementary motor area (SMA), superior frontal gyrus, pallidus, caudate, and parahippocampal gyrus. Further, greater functional connectivity between the OFC and anterior cingulate/medial frontal gyrus was associated with less behavior change (e.g., greater post-treatment cannabis problems). These data support the role of the OFC network as a mechanism of adolescent treatment response.
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Affiliation(s)
- Sarah W Feldstein Ewing
- Oregon Health & Science University, Department of Psychiatry, 3181 SW Sam Jackson Park Rd., M/C DC7P, Portland, OR 97239, USA.
| | - Tammy Chung
- University of Pittsburgh School of Medicine, Departments of Psychiatry and Psychology, 3811 O'Hara St., Pittsburgh, PA 15213, USA.
| | - Justin D Caouette
- Oregon Health & Science University, Department of Psychiatry, 3181 SW Sam Jackson Park Rd., M/C DC7P, Portland, OR 97239, USA.
| | - Arielle Ketcherside
- Center for BrainHealth, School of Behavioral and Brain Sciences, The University of Texas at Dallas, 2200 West Mockingbird Lane, Dallas, TX 75235, USA.
| | - Karen A Hudson
- Oregon Health & Science University, Department of Psychiatry, 3181 SW Sam Jackson Park Rd., M/C DC7P, Portland, OR 97239, USA.
| | - Francesca M Filbey
- Center for BrainHealth, School of Behavioral and Brain Sciences, The University of Texas at Dallas, 2200 West Mockingbird Lane, Dallas, TX 75235, USA.
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Feldstein Ewing SW, Apodaca TR, Gaume J. Ambivalence: Prerequisite for success in motivational interviewing with adolescents? Addiction 2016; 111:1900-1907. [PMID: 26814983 PMCID: PMC4963310 DOI: 10.1111/add.13286] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Revised: 08/05/2015] [Accepted: 12/07/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIMS The exploration and resolution of ambivalence play an essential role in motivational interviewing (MI) theory. However, most adolescent MI studies have not examined ambivalence as a contributor to behaviour change. This paper reviewed research findings on the role of ambivalence in the adolescent change process. METHODS AND RESULTS We undertook a narrative review of the published empirical and theoretical literature on ambivalence and mechanisms of change in MI for adolescents and found that current MI evaluations appear not to have access to reliable and valid measures of ambivalence in adolescence or neuroimaging methods to evaluate the mechanisms of treatment response. CONCLUSIONS Improved instrumentation is needed to assess adolescents' ambivalence in clinical and research settings. Innovative methodology, including neuroimaging, may help identify factors mediating relationships between adolescents' ambivalence and treatment response.
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Affiliation(s)
- S. W. Feldstein Ewing
- Oregon Health & Science University, Department of Child & Adolescent Psychiatry, Portland, OR USA
| | - T. R. Apodaca
- Children’s Mercy Kansas City, Kansas City, MO USA,University of Missouri-Kansas City School of Medicine, Department of Pediatrics, Kansas City, MO USA
| | - J. Gaume
- Lausanne University Hospital, Department of Community Health and Medicine, Alcohol Treatment Center, Lausanne, Switzerland
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Borsari B, Apodaca TR, Yurasek A, Monti PM. Does mental status impact therapist and patient communication in emergency department brief interventions addressing alcohol use? J Subst Abuse Treat 2016; 73:1-8. [PMID: 28017179 DOI: 10.1016/j.jsat.2016.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 09/18/2016] [Accepted: 10/04/2016] [Indexed: 10/20/2022]
Abstract
Motivational interviewing (MI) is often incorporated into screening, brief intervention, and referral to treatment (SBIRT) interventions in critical care settings to address alcohol and other drug use. However, cognitive status has been linked to differential response to MI sessions in emergency department (ED) settings. The current study examined one possible explanation for this differential response: whether higher versus lower mental status impacts patient response to clinician statements during MI sessions conducted in an ED. Participants were 126 patients receiving an MI-based single-session alcohol brief intervention, and 13 therapists who provided treatment. Participants completed a mental status exam (MSE) as part of the screening process. Intervention sessions were audio-taped, and transcribed and coded using the Motivational Interviewing Skills Code (MISC 2.0; Miller, Moyers, Ernst, & Amrhein, 2003). The MISC 2.0 coded therapist behaviors that are related to the use of motivational interviewing, and patient language reflecting movement toward (change talk) or away from (sustain talk) changing personal alcohol use. Overall, patients responded in a similar manner to therapist MI behaviors regardless of high versus low level of mental functioning at the time of the intervention. Group differences emerged on patient response to only three specific therapist skills: giving information, open questions, and complex reflection. Thus, the differential effects of SBIRT in critical care settings do not appear to be a result of differences in the therapist and patient communication process.
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Affiliation(s)
- Brian Borsari
- Mental Health Service (116B), San Francisco VA Medical Center, 4150 Clement St., San Francisco, CA 94121; Department of Behavioral and Social Sciences, and Center for Alcohol and Addiction Studies, Brown University, Box G-S121-4, Providence, RI 02912; Department of Psychiatry, University of California, San Francisco, 401 Parnassus Ave., San Francisco, CA 94143.
| | - Timothy R Apodaca
- Children's Mercy Kansas City, 2401 Gillham Rd., Kansas City, MO, 64108; University of Missouri-Kansas City School of Medicine, 3901 Rainbow Blvd, Kansas City, KS 66103
| | - Ali Yurasek
- Department of Behavioral and Social Sciences, and Center for Alcohol and Addiction Studies, Brown University, Box G-S121-4, Providence, RI 02912
| | - Peter M Monti
- Department of Behavioral and Social Sciences, and Center for Alcohol and Addiction Studies, Brown University, Box G-S121-4, Providence, RI 02912
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Chung T, Noronha A, Carroll KM, Potenza MN, Hutchison K, Calhoun VD, Gabrieli JDE, Morgenstern J, Nixon SJ, Wexler BE, Brewer J, Ray L, Filbey F, Strauman TJ, Kober H, Feldstein Ewing SW. Brain mechanisms of Change in Addictions Treatment: Models, Methods, and Emerging Findings. CURRENT ADDICTION REPORTS 2016; 3:332-342. [PMID: 27990326 PMCID: PMC5155705 DOI: 10.1007/s40429-016-0113-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Increased understanding of "how" and "for whom" treatment works at the level of the brain has potential to transform addictions treatment through the development of innovative neuroscience-informed interventions. The 2015 Science of Change meeting bridged the fields of neuroscience and psychotherapy research to identify brain mechanisms of behavior change that are "common" across therapies, and "specific" to distinct behavioral interventions. Conceptual models of brain mechanisms underlying effects of Cognitive Behavioral Therapy, mindfulness interventions, and Motivational Interviewing were discussed. Presentations covered methods for integrating neuroimaging into psychotherapy research, and novel analytic approaches. Effects of heavy substance use on the brain, and recovery of brain functioning with sustained abstinence, which may be facilitated by cognitive training, were reviewed. Neuroimaging provides powerful tools for determining brain mechanisms underlying psychotherapy and medication effects, predicting and monitoring outcomes, developing novel interventions that target specific brain circuits, and identifying for whom an intervention will be effective.
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Affiliation(s)
- Tammy Chung
- University of Pittsburgh, 3811 O’Hara Street, Pittsburgh, PA 15213, Phone: 412-246-5147, Fax: 412-246-6550
| | - Antonio Noronha
- National Institute on Alcohol Abuse and Alcoholism, 5635 Fishers Lane, Bethesda, MD, Phone: 301-443-7722, Fax: 301-443-1650
| | - Kathleen M. Carroll
- Yale University, 950 Campbell Avenue, MIRECC 151D, West Haven, CT 06516, Phone: 203-932-3869 x7403, Fax: 203-937-3869
| | - Marc N. Potenza
- Yale University, 34 Park St, New Haven, CT 06519, Phone: 203-974-7356, Fax: 203-974-7366
| | - Kent Hutchison
- University of Colorado at Boulder, Muenzinger Psychology, 345 UCB, Boulder, CO 80309, Phone: 303-492-8163
| | - Vince D. Calhoun
- The Mind Research Network, The University of New Mexico, 1 University of New Mexico, Albuquerque, NM 87131, Phone: 505-272-1817, Fax: 505-272-8002
| | - John D. E. Gabrieli
- McGovern Institute for Brain Research, Massachusetts Institute of Technology, 43 Vassar Street, Building 46-4033, Cambridge, MA 02139, Phone: 617-253-8946, Fax: 617-324-5311
| | - Jon Morgenstern
- Northwell Health, 1010 Northern Blvd, Great Neck, NY 11021, Phone: 516-837-1694
| | - Sara Jo Nixon
- McKnight Brain Institute, University of Florida, PO Box 100256, Gainesville, FL 32610, Phone: 352-294-4920
| | - Bruce E. Wexler
- Yale University, 34 Park St, New Haven, CT 06519, Phone: 203-974-7339
| | - Judson Brewer
- University of Massachusetts Medical School, Worcester, MA 01655 and Yale University School of Medicine, New Haven, CT 06515, Phone: 508-856-1632; Fax 508-856-1977
| | - Lara Ray
- Department of Psychology, University of California at Los Angeles, 1285 Franz Hall, Los Angeles, CA 90095, Phone: 310-794-5383
| | - Francesca Filbey
- University of Texas at Dallas Center for Brain Health, 2200 West Mockingbird Lane, Dallas, TX 75235, Phone: 972-883-3204
| | - Timothy J. Strauman
- Duke University, 316 Soc-psych Building, Durham, NC 27708, Phone: 919-660-5709
| | - Hedy Kober
- Yale University, 1 Church Street, Suite 701, New Haven, CT 06525, Phone: 203-737-5641
| | - Sarah W. Feldstein Ewing
- Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239, Phone: 503-418-9604
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DeWitt SJ, Ketcherside A, McQueeny TM, Dunlop JP, Filbey FM. The hyper-sentient addict: an exteroception model of addiction. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2016; 41:374-81. [PMID: 26154169 DOI: 10.3109/00952990.2015.1049701] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Exteroception involves processes related to the perception of environmental stimuli important for an organism's ability to adapt to its environment. As such, exteroception plays a critical role in conditioned response. In addiction, behavioral and neuroimaging studies show that the conditioned response to drug-related cues is often associated with alterations in brain regions including the precuneus/posterior cingulate cortex, an important node within the default mode network dedicated to processes such as self-monitoring. OBJECTIVE This review aimed to summarize the growing, but largely fragmented, literature that supports a central role of exteroceptive processes in addiction. METHODS We performed a systematic review of empirical research via PubMed and Google Scholar with keywords including 'addiction', 'exteroception', 'precuneus', and 'self-awareness', to identify human behavioral and neuroimaging studies that report mechanisms of self-awareness in healthy populations, and altered self-awareness processes, specifically exteroception, in addicted populations. RESULTS Results demonstrate that exteroceptive processes play a critical role in conditioned cue response in addiction and serve as targets for interventions such as mindfulness training. Further, a hub of the default mode network, namely, the precuneus, is (i) consistently implicated in exteroceptive processes, and (ii) widely demonstrated to have increased activation and connectivity in addicted populations. CONCLUSION Heightened exteroceptive processes may underlie cue-elicited craving, which in turn may lead to the maintenance and worsening of substance use disorders. An exteroception model of addiction provides a testable framework from which novel targets for interventions can be identified.
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Affiliation(s)
- Samuel J DeWitt
- a Center for BrainHealth, University of Texas at Dallas , Dallas , TX , USA
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Feldstein Ewing SW, Tapert SF, Molina BSG. Uniting adolescent neuroimaging and treatment research: Recommendations in pursuit of improved integration. Neurosci Biobehav Rev 2016; 62:109-14. [PMID: 26748378 PMCID: PMC4767630 DOI: 10.1016/j.neubiorev.2015.12.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 11/10/2015] [Accepted: 12/19/2015] [Indexed: 12/21/2022]
Abstract
Many clinicians who provide mental health treatment find developmental neuroscience discoveries to be exciting. However, the utility of these findings often seem far removed from everyday clinical care. Thus, the goal of this article is to offer a bridge to connect the fields of applied adolescent treatment and developmental neuroscience investigation. An overview of the relevance of developmental neuroscience in adolescent direct practice and a rationale for how and why this integration could benefit adolescent treatment outcomes is provided. Finally, a series of practical suggestions is generated for enhancing collaborative, interdisciplinary work that ultimately advances treatment response for this important clinical population.
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Affiliation(s)
- Sarah W Feldstein Ewing
- Oregon Health & Science University, Department of Psychiatry, 3314 SW US Veteran's Hospital Rd. M/C DC7P, Portland, OR 97239, USA.
| | - Susan F Tapert
- VA San Diego Healthcare System, Psychology Service (116B), 3350 La Jolla Village Drive, San Diego, CA 92161, USA; University of California San Diego, Department of Psychiatry, 9500 Gilman Drive, La Jolla, CA 92093-0603 V, USA.
| | - Brooke S G Molina
- University of Pittsburgh School of Medicine, Departments of Psychiatry and Psychology, 3811 O'Hara St., Pittsburgh, PA 15213, USA.
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Vingerhoets WAM, Koenders L, van den Brink W, Wiers RW, Goudriaan AE, van Amelsvoort T, de Haan L, Cousijn J. Cue-induced striatal activity in frequent cannabis users independently predicts cannabis problem severity three years later. J Psychopharmacol 2016; 30:152-8. [PMID: 26645206 DOI: 10.1177/0269881115620436] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Cannabis is the most frequently used illicit drug worldwide, but little is known about the mechanisms underlying continued cannabis use. Cue-reactivity (the physical, psychological, behavioural and neural reaction to substance-related cues) might be related to continued cannabis use. In this 3-year prospective neuroimaging study we investigated whether cannabis cue-induced brain activity predicted continued cannabis use and associated problem severity 3 years later. In addition, baseline brain activations were compared between dependent and non-dependent cannabis users at follow-up. Analyses were focussed on brain areas known to be important in cannabis cue-reactivity: anterior cingulate cortex, orbitofrontal cortex, ventral tegmental area, amygdala and striatum. At baseline, 31 treatment-naive frequent cannabis users performed a cue-reactivity functional magnetic resonance imaging task. Of these participants, 23 completed the 3-year follow-up. None of the cue-induced region of interest activations predicted the amount of cannabis use at follow-up. However, cue-induced activation in the left striatum (putamen) significantly and independently predicted problem severity at follow-up (p < 0.001) as assessed with the Cannabis Use Disorder Identification Test. Also, clinically dependent cannabis users at follow-up showed higher baseline activation at trend level in the left striatum compared with non-dependent users. This indicates that neural cue-reactivity in the dorsal striatum is an independent predictor of cannabis use-related problems. Given the relatively small sample size, these results are preliminary and should be replicated in larger samples of cannabis users.
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Affiliation(s)
- W A M Vingerhoets
- Department of Psychiatry and Psychology, Maastricht University, Maastricht, the Netherlands Department of Nuclear Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
| | - L Koenders
- Department of Psychiatry, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
| | - W van den Brink
- Department of Psychiatry, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
| | - R W Wiers
- Addiction, Development and Psychopathology (ADAPT) lab, Department of Developmental Psychology, University of Amsterdam, Amsterdam, the Netherlands
| | - A E Goudriaan
- Department of Psychiatry, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands Arkin Mental Health Care, Amsterdam, the Netherlands
| | - T van Amelsvoort
- Department of Psychiatry and Psychology, Maastricht University, Maastricht, the Netherlands
| | - L de Haan
- Department of Psychiatry, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
| | - J Cousijn
- Department of Psychiatry, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands Addiction, Development and Psychopathology (ADAPT) lab, Department of Developmental Psychology, University of Amsterdam, Amsterdam, the Netherlands Department of Developmental and Experimental Psychology, Utrecht University, Utrecht, the Netherlands
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Jones SA, Cservenka A, Nagel BJ. Binge drinking impacts dorsal striatal response during decision making in adolescents. Neuroimage 2016; 129:378-388. [PMID: 26826511 DOI: 10.1016/j.neuroimage.2016.01.044] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Revised: 01/20/2016] [Accepted: 01/20/2016] [Indexed: 02/02/2023] Open
Abstract
Adolescence is a time of both increased risk taking and increased vulnerability to the neurotoxic effects of alcohol. However, it is unclear whether brain functioning abnormalities in adolescent binge drinkers are a result of alcohol use itself or whether they represent premorbid risk characteristics. The current study addresses this question by using a modified version of the Wheel of Fortune (WOF) task, during functional magnetic resonance imaging (fMRI), at both baseline, while all subjects were alcohol-naïve, and revisit, when half of the subjects had emerged into regular binge drinking (n=13) and half remained alcohol and substance-naïve (n=13). Region of interest (ROI) analysis revealed that during decision making, there was a significant binge-drinking related reduction in brain activation in the dorsal striatum, an effect associated with degree of recent use. Furthermore, whole-brain analysis revealed a decrease in fronto-parietal brain activation prior to initiation of alcohol use, in adolescents who went on to binge drink. Additionally, there were numerous regions, both cortical and subcortical, in which there was a significant time-related developmental change, across groups. These results demonstrate how abnormalities in decision-making related circuitry might both lead to and perpetuate alcohol drinking behavior. These findings help aid in our ability to disentangle consequences of binge drinking from potential risk markers for future binge drinking, and may help guide future prevention and intervention strategies.
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Affiliation(s)
| | | | - Bonnie J Nagel
- Departments of Psychiatry, USA; Behavioral Neuroscience, USA.
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37
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Thayer RE, Feldstein Ewing SW. Adolescent psychotherapy for addiction medicine. PROGRESS IN BRAIN RESEARCH 2016; 224:305-22. [DOI: 10.1016/bs.pbr.2015.07.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
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38
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Black JJ, Chung T. Mechanisms of change in adolescent substance use treatment: how does treatment work? Subst Abus 2015; 35:344-51. [PMID: 24901750 DOI: 10.1080/08897077.2014.925029] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Adolescent substance use treatment outcome research generally shows small to moderate effects in reducing substance use, with no specific "brand" of treatment emerging as clearly superior to any other, and treatment gains that fade over time. The relatively weak and temporary effects of treatment call for improving the potency and durability of intervention effects. In response to this call, this critical narrative review summarizes research on mechanisms of change for both adults and adolescents in substance use treatment, with a particular focus on reviewing what is known regarding "how" adolescent substance use treatment works. METHODS A comprehensive review of the adolescent (aged 11-18) substance use treatment literature was conducted to identify empirical studies that examined mediators of intervention effects. Relevant databases (e.g., PsychINFO, MEDLINE) were searched using key words (e.g., "mediator"), and relevant articles from reference sections of identified studies and review papers were considered. RESULTS Studies of mechanisms of psychotherapy change are rare in the adult, and particularly adolescent, substance use treatment outcome literature. The 4 adolescent studies that examined substance use treatment mechanisms found that positive social support, motivation to abstain, and positive parenting behaviors mediated treatment effects. To date, research has not supported therapy-specific mechanisms of change, finding instead that "common" processes of change largely account for improvements in outcome across distinct "brands" of treatment. CONCLUSIONS The lack of empirical support for treatment-specific mechanisms of change may be due to the need for greater precision in defining and measuring treatment-specific causal chains. Future directions include neuroscience approaches to examining changes in brain functioning that are associated with treatment response and recovery and examining mechanisms in adaptive treatment designs, which can accommodate individual differences in targets for intervention and response to treatment.
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Affiliation(s)
- Jessica J Black
- a Western Psychiatric Institute and Clinic , University of Pittsburgh Medical Center , Pittsburgh , Pennsylvania , USA
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Grewen K, Salzwedel AP, Gao W. Functional Connectivity Disruption in Neonates with Prenatal Marijuana Exposure. Front Hum Neurosci 2015; 9:601. [PMID: 26582983 PMCID: PMC4631947 DOI: 10.3389/fnhum.2015.00601] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 10/18/2015] [Indexed: 01/17/2023] Open
Abstract
Prenatal marijuana exposure (PME) is linked to neurobehavioral and cognitive impairments; however, findings in childhood and adolescence are inconsistent. Type-1 cannabinoid receptors (CB1R) modulate fetal neurodevelopment, mediating PME effects on growth of functional circuitry sub-serving behaviors critical for academic and social success. The purpose of this study was to investigate the effects of prenatal marijuana on development of early brain functional circuitry prior to prolonged postnatal environmental influences. We measured resting state functional connectivity during unsedated sleep in infants at 2–6 weeks (+MJ: 20 with PME in combination with nicotine, alcohol, opiates, and/or selective serotonin reuptake inhibitors; −MJ: 23 exposed to the same other drugs without marijuana, CTR: 20 drug-free controls). Connectivity of subcortical seed regions with high fetal CB1R expression was examined. Marijuana-specific differences were observed in insula and three striatal connections: anterior insula–cerebellum, right caudate–cerebellum, right caudate–right fusiform gyrus/inferior occipital, left caudate–cerebellum. +MJ neonates had hypo-connectivity in all clusters compared with −MJ and CTR groups. Altered striatal connectivity to areas involved in visual spatial and motor learning, attention, and in fine-tuning of motor outputs involved in movement and language production may contribute to neurobehavioral deficits reported in this at-risk group. Disrupted anterior insula connectivity may contribute to altered integration of interoceptive signals with salience estimates, motivation, decision-making, and later drug use. Compared with CTRs, both +MJ and −MJ groups demonstrated hyper-connectivity of left amygdala seed with orbital frontal cortex and hypo-connectivity of posterior thalamus seed with hippocampus, suggesting vulnerability to multiple drugs in these circuits.
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Affiliation(s)
- Karen Grewen
- Department of Psychiatry, Neurobiology, and Psychology, University of North Carolina Chapel Hill , Chapel Hill, NC , USA
| | - Andrew P Salzwedel
- Department of Radiology, Biomedical Research Imaging Center, University of North Carolina Chapel Hill , Chapel Hill, NC , USA ; Department of Biomedical Sciences and Imaging, Biomedical Imaging Research Institute, Cedars-Sinai Medical Cente , Los Angeles, CA , USA
| | - Wei Gao
- Department of Radiology, Biomedical Research Imaging Center, University of North Carolina Chapel Hill , Chapel Hill, NC , USA ; Department of Biomedical Sciences and Imaging, Biomedical Imaging Research Institute, Cedars-Sinai Medical Cente , Los Angeles, CA , USA
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Feldstein Ewing SW, Houck JM, Yezhuvath U, Shokri-Kojori E, Truitt D, Filbey FM. The impact of therapists' words on the adolescent brain: In the context of addiction treatment. Behav Brain Res 2015; 297:359-69. [PMID: 26455873 DOI: 10.1016/j.bbr.2015.09.041] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Revised: 09/09/2015] [Accepted: 09/28/2015] [Indexed: 11/26/2022]
Abstract
At this time, we still do not know how therapist behaviors influence adolescent brain response and related treatment outcomes. Therefore, we examined this question with 17 binge drinking youth (mean age=16.62 years; 64.3% female; 42.9% Hispanic; 28.6% bi-/multi-racial). In this within-subjects design, all youth completed a baseline assessment, two therapy sessions, an fMRI scan, and were re-evaluated for behavior change at one-month post-treatment. During the fMRI session, youth were presented with two types of responses from their treating therapist: higher-skill statements prescribed in an empirically-supported addiction treatment (complex reflections) vs. language standard within addiction treatment more broadly (closed questions). In terms of behavior change, at the one-month follow-up, youth showed significant reductions in number of drinking days and binge drinking days. Further, we found main effects for complex reflections and closed questions across the superior middle temporal gyrus and middle temporal gyrus (FWE-corrected, p<.05). Greater brain response was observed for complex reflections versus closed questions within the bilateral anterior cingulate gyrus. Greater BOLD response in the parietal lobe during closed questions was significantly associated with less post-treatment drinking. Lower BOLD response during complex reflections and closed questions in the precuneus were associated with greater post-treatment ratings of importance of changing. This study represents a first step in understanding how therapist behaviors influence the developing adolescent brain and how that neural response may be associated with youth treatment outcomes.
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Affiliation(s)
- Sarah W Feldstein Ewing
- Oregon Health & Science University, Department of Psychiatry, 3314 SW US Veteran's Hospital Road, M/C DC7P, Portland, OR 97239, USA.
| | - Jon M Houck
- University of New Mexico Department of Psychology and Center on Alcoholism, Substance Abuse, and Addictions (UNM CASAA), 2650 Yale Blvd SE, MSC11 6280, Albuquerque, NM 87106, USA.
| | - Uma Yezhuvath
- Advance MRI LLC, 8700 Stonebrook Parkway, #105, Frisco, TX 75034, USA.
| | | | - Dustin Truitt
- University of New Mexico Department of Psychology and Center on Alcoholism, Substance Abuse, and Addictions (UNM CASAA), 2650 Yale Blvd SE, MSC11 6280, Albuquerque, NM 87106, USA.
| | - Francesca M Filbey
- Center for BrainHealth, School of Behavioral and Brain Sciences, The University of Texas at Dallas, 2200 West Mockingbird Lane, Dallas, TX 75235, USA.
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Regional brain activation supporting cognitive control in the context of reward is associated with treated adolescents' marijuana problem severity at follow-up: A preliminary study. Dev Cogn Neurosci 2015; 16:93-100. [PMID: 26026506 PMCID: PMC4644722 DOI: 10.1016/j.dcn.2015.05.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Revised: 05/05/2015] [Accepted: 05/07/2015] [Indexed: 11/29/2022] Open
Abstract
Activation during rewarded antisaccade task correlated with later marijuana severity. Antisaccade behavioral performance was not associated with treatment outcome. Preliminary results suggest a brain-based correlate of treatment outcome in youth.
This preliminary study examined the extent to which regional brain activation during a reward cue antisaccade (AS) task was associated with 6-month treatment outcome in adolescent substance users. Antisaccade performance provides a sensitive measure of executive function and cognitive control, and generally improves with reward cues. We hypothesized that when preparing to execute an AS, greater activation in regions associated with cognitive and oculomotor control supporting AS, particularly during reward cue trials, would be associated with lower substance use severity at 6-month follow-up. Adolescents (n = 14, ages 14–18) recruited from community-based outpatient treatment completed an fMRI reward cue AS task (reward and neutral conditions), and provided follow-up data. Results indicated that AS errors decreased in reward, compared to neutral, trials. AS behavioral performance, however, was not associated with treatment outcome. As hypothesized, activation in regions of interest (ROIs) associated with cognitive (e.g., ventrolateral prefrontal cortex) and oculomotor control (e.g., supplementary eye field) during reward trials were inversely correlated with marijuana problem severity at 6-months. ROI activation during neutral trials was not associated with outcomes. Results support the role of motivational (reward cue) factors to enhance cognitive control processes, and suggest a potential brain-based correlate of youth treatment outcome.
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Feldstein Ewing SW, Yezhuvath U, Houck JM, Filbey FM. Brain-based origins of change language: a beginning. Addict Behav 2014; 39:1904-10. [PMID: 25150658 DOI: 10.1016/j.addbeh.2014.07.035] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Revised: 06/26/2014] [Accepted: 07/31/2014] [Indexed: 10/24/2022]
Abstract
Motivational interviewing (MI) is a promising treatment for heavy drinking. Client change talk (CT), a critical component of MI, has been associated with differential brain activation. The goal of this study was to begin to deconstruct how and why CT may affect the brain. Specifically, we sought to determine whether simply repeating statements in favor of change would cause differential brain activation, or whether client statements must be spontaneously generated within a therapeutic milieu in order to influence brain activation. We therefore examined blood oxygenation level dependent (BOLD) response following two types of client language (CT; and sustain talk, ST) across two conditions: (1) Self-Generated: CT and ST were elicited during an MI session vs. (2) Experimenter-Selected: a pre-established list of CT and ST was provided to the individual in the absence of an MI session. Across both conditions, participants' CT and ST were visually and aurally presented during fMRI. We enrolled 39 recent binge drinkers (41% male; M age=19.9; n=18 in Self-Generated group; n=21 in Experimenter-Selected group). We found that both types of client language (CT and ST) elicited greater BOLD activation in the Self-Generated vs. the Experimenter-Selected group in the left inferior frontal gyrus/anterior insula and superior temporal gyri (p≤0.001). These findings indicate that the nature of client language matters. It appears that it is not just the words themselves, but the origin (naturally generated within a therapeutic session) that influences brain-based effects.
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Kober H, DeVito EE, DeLeone CM, Carroll KM, Potenza MN. Cannabis abstinence during treatment and one-year follow-up: relationship to neural activity in men. Neuropsychopharmacology 2014; 39:2288-98. [PMID: 24705568 PMCID: PMC4138744 DOI: 10.1038/npp.2014.82] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Revised: 03/24/2014] [Accepted: 03/25/2014] [Indexed: 11/09/2022]
Abstract
Cannabis is among the most frequently abused substances in the United States. Cognitive control is a contributory factor in the maintenance of substance-use disorders and may relate to treatment response. Therefore, we assessed whether cognitive-control-related neural activity before treatment differs between treatment-seeking cannabis-dependent and healthy individuals and relates to cannabis-abstinence measures during treatment and 1-year follow-up. Cannabis-dependent males (N=20) completed a functional magnetic resonance imaging (fMRI) cognitive-control (Stroop) task before a 12-week randomized controlled trial of cognitive-behavioral therapy and/or contingency management. A healthy-comparison group (N=20) also completed the fMRI task. Cannabis use was assessed by urine toxicology and self-report during treatment, and by self-report across a 1-year follow-up period (N=18). The cannabis-dependent group displayed diminished Stroop-related neural activity relative to the healthy-comparison group in multiple regions, including those strongly implicated in cognitive-control and addiction-related processes (eg, dorsolateral prefrontal cortex and ventral striatum). The groups did not differ significantly in response times (cannabis-dependent, N=12; healthy-comparison, N=14). Within the cannabis-dependent group, greater Stroop-related activity in regions including the dorsal anterior cingulate cortex was associated with less cannabis use during treatment. Greater activity in regions including the ventral striatum was associated with less cannabis use during 1-year posttreatment follow-up. These data suggest that lower cognitive-control-related neural activity in classic 'control' regions (eg, dorsolateral prefrontal cortex and dorsal anterior cingulate) and classic 'salience/reward/learning' regions (eg, ventral striatum) differentiates cannabis-dependent individuals from healthy individuals and relates to less abstinence within-treatment and during long-term follow-up. Clinically, results suggest that treatment development efforts that focus on enhancing cognitive control in addition to abstinence may improve treatment outcomes in cannabis dependence.
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Affiliation(s)
- Hedy Kober
- Department of Psychiatry, Yale University, New Haven, CT, USA
| | - Elise E DeVito
- Department of Psychiatry, Yale University, New Haven, CT, USA
| | | | | | - Marc N Potenza
- Department of Psychiatry, Yale University, New Haven, CT, USA
- Departments of Neurobiology and Child Study Center, Yale University, New Haven, CT, USA
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Ewing SWF, Sakhardande A, Blakemore SJ. The effect of alcohol consumption on the adolescent brain: A systematic review of MRI and fMRI studies of alcohol-using youth. NEUROIMAGE-CLINICAL 2014; 5:420-37. [PMID: 26958467 PMCID: PMC4749850 DOI: 10.1016/j.nicl.2014.06.011] [Citation(s) in RCA: 119] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background A large proportion of adolescents drink alcohol, with many engaging in high-risk patterns of consumption, including binge drinking. Here, we systematically review and synthesize the existing empirical literature on how consuming alcohol affects the developing human brain in alcohol-using (AU) youth. Methods For this systematic review, we began by conducting a literature search using the PubMED database to identify all available peer-reviewed magnetic resonance imaging (MRI) and functional magnetic resonance imaging (fMRI) studies of AU adolescents (aged 19 and under). All studies were screened against a strict set of criteria designed to constrain the impact of confounding factors, such as co-occurring psychiatric conditions. Results Twenty-one studies (10 MRI and 11 fMRI) met the criteria for inclusion. A synthesis of the MRI studies suggested that overall, AU youth showed regional differences in brain structure as compared with non-AU youth, with smaller grey matter volumes and lower white matter integrity in relevant brain areas. In terms of fMRI outcomes, despite equivalent task performance between AU and non-AU youth, AU youth showed a broad pattern of lower task-relevant activation, and greater task-irrelevant activation. In addition, a pattern of gender differences was observed for brain structure and function, with particularly striking effects among AU females. Conclusions Alcohol consumption during adolescence was associated with significant differences in structure and function in the developing human brain. However, this is a nascent field, with several limiting factors (including small sample sizes, cross-sectional designs, presence of confounding factors) within many of the reviewed studies, meaning that results should be interpreted in light of the preliminary state of the field. Future longitudinal and large-scale studies are critical to replicate the existing findings, and to provide a more comprehensive and conclusive picture of the effect of alcohol consumption on the developing brain. A large proportion of adolescents drink alcohol. Studies show how alcohol affects human adolescent brain development. This includes a systematic review of MRI and fMRI studies in alcohol-using youth. Changes in structure and function are observed in the brain in alcohol-using youth.
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Affiliation(s)
| | - Ashok Sakhardande
- UCL Institute of Cognitive Neuroscience, 17 Queen Square, London WC1N 3AR, UK
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Lisdahl KM, Wright NE, Kirchner-Medina C, Maple KE, Shollenbarger S. Considering Cannabis: The Effects of Regular Cannabis Use on Neurocognition in Adolescents and Young Adults. CURRENT ADDICTION REPORTS 2014; 1:144-156. [PMID: 25013751 PMCID: PMC4084860 DOI: 10.1007/s40429-014-0019-6] [Citation(s) in RCA: 107] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Thirty-six percent of high school seniors have used cannabis in the past year, and an alarming 6.5% smoked cannabis daily, up from 2.4% in 1993 (Johnston et al., 2013). Adolescents and emerging adults are undergoing significant neurodevelopment and animal studies suggest they may be particularly vulnerable to negative drug effects. In this review, we will provide a detailed overview of studies outlining the effects of regular (at least weekly) cannabis use on neurocognition, including studies outlining cognitive, structural and functional findings. We will also explore the public health impact of this research.
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Affiliation(s)
- Krista M. Lisdahl
- Department of Psychology, University of Wisconsin-Milwaukee, Milwaukee, WI
| | - Natasha E. Wright
- Department of Psychology, University of Wisconsin-Milwaukee, Milwaukee, WI
| | | | - Kristin E. Maple
- Department of Psychology, University of Wisconsin-Milwaukee, Milwaukee, WI
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Houck JM, Bryan AD, Feldstein Ewing SW. Functional connectivity and cannabis use in high-risk adolescents. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2013; 39:414-23. [PMID: 24200211 PMCID: PMC4070738 DOI: 10.3109/00952990.2013.837914] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Adolescence is a unique neurodevelopmental period when regions of the brain most able to assess risk and reward are still in development. Cannabis use during adolescence has been associated with persistent negative outcomes. Although measures of resting brain activity are useful in assessing functional connectivity, such measures have not been broadly applied in adolescent cannabis-users. OBJECTIVES The goal of the present study was to analyze the associations between cannabis use and resting brain activity in a sample of high-risk adolescents. METHODS Eighty-two high-risk youth between 14-18 years old were recruited from a juvenile justice day program. Youth completed a brief neurocognitive battery including assessments of cannabis use and a 5-minute resting functional magnetic resonance imaging (fMRI) scan. Intrinsic connectivity networks were extracted using the GIFT toolbox. Brain activity in a fronto-temporal network was compared in youth with high cannabis use vs. low cannabis use using an independent-samples t-test with alcohol use entered as a covariate. RESULTS Analysis revealed two elements within the fronto-temporal network related to cannabis use: one in middle frontal gyrus related to high cannabis use, and one in middle temporal gyrus related to low cannabis use. Only the frontal source survived application of a cluster size threshold and was significant at p < 0.005. CONCLUSIONS These results are consistent with patterns of activity in adult cannabis-users. The observed effect may reflect either pre-existing risk factors or near-term consequences of cannabis use. Prevention and intervention strategies that address fronto-temporal functioning may be particularly helpful in this population.
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Feldstein Ewing SW, Chung T. Neuroimaging mechanisms of change in psychotherapy for addictive behaviors: emerging translational approaches that bridge biology and behavior. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2013; 27:329-35. [PMID: 23815447 PMCID: PMC3864922 DOI: 10.1037/a0031491] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Research on mechanisms of behavior change provides an innovative method to improve treatment for addictive behaviors. An important extension of mechanisms of change research involves the use of translational approaches, which examine how basic biological (i.e., brain-based mechanisms) and behavioral factors interact in initiating and sustaining positive behavior change as a result of psychotherapy. Articles in this special issue include integrative conceptual reviews and innovative empirical research on brain-based mechanisms that may underlie risk for addictive behaviors and response to psychotherapy from adolescence through adulthood. Review articles discuss hypothesized mechanisms of change for cognitive and behavioral therapies, mindfulness-based interventions, and neuroeconomic approaches. Empirical articles cover a range of addictive behaviors, including use of alcohol, cigarettes, marijuana, cocaine, and pathological gambling and represent a variety of imaging approaches including fMRI, magneto-encephalography, real-time fMRI, and diffusion tensor imaging. Additionally, a few empirical studies directly examine brain-based mechanisms of change, whereas others examine brain-based indicators as predictors of treatment outcome. Finally, two commentaries discuss craving as a core feature of addiction, and the importance of a developmental approach to examining mechanisms of change. Ultimately, translational research on mechanisms of behavior change holds promise for increasing understanding of how psychotherapy may modify brain structure and functioning and facilitate the initiation and maintenance of positive treatment outcomes for addictive behaviors.
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Affiliation(s)
- Sarah W Feldstein Ewing
- University Honors College/University of New Mexico Center on Alcoholism, Substance Abuse, and Addiction, Albuquerque, NM 87131, USA.
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Callahan TJ, Montanaro E, Magnan RE, Bryan AD. Project MARS: Design of a Multi-Behavior Intervention Trial for Justice-Involved Youth. Transl Behav Med 2013; 3:122-130. [PMID: 23458992 DOI: 10.1007/s13142-013-0192-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Marijuana and alcohol use are associated with increased sexual risk behavior among justice-involved youth. A multi-behavior intervention may reduce all three risk behaviors. PURPOSE To examine the relationships among multiple risk behaviors and the Theory of Planned Behavior (TPB) constructs guiding the development of the MARS (Motivating Adolescents to Reduce Sexual risk) intervention. We describe the MARS study design to inform the process through which a multi-behavior intervention trial can be implemented and evaluated. METHODS Participants completed questionnaires prior to randomization to one of three interventions. RESULTS Relationships were found between TPB constructs and risk behavior. A single latent variable was inadequate to capture all three risk behaviors. CONCLUSIONS Interventions to reduce sexual risk behavior can include content related to the role of substance use in influencing sexual risk behavior with only minimal modifications to the curriculum, and preliminary data suggest a common theory can apply across risk behaviors.
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Ewing SWF, Mead HK, Yezhuvath U, DeWitt S, Hutchison KE, Filbey FM. A preliminary examination of how serotonergic polymorphisms influence brain response following an adolescent cannabis intervention. Psychiatry Res 2012; 204:112-6. [PMID: 23217578 PMCID: PMC3544473 DOI: 10.1016/j.pscychresns.2012.10.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2012] [Revised: 10/04/2012] [Accepted: 10/09/2012] [Indexed: 11/28/2022]
Abstract
Given the link between depression, anxiety, and cannabis abuse, a serotonin receptor (rs6311) and transporter polymorphism (rs2020936) were examined as moderators of neural response as measured by functional magnetic resonance imaging following a psychosocial treatment for cannabis use disorders (CUDs). While the proposed hypotheses were unsupported, we found that the rs6311 C allele was significantly related to brain activation (medial frontal gyrus, precuneus), indicating the role of this serotonin receptor in adolescent treatment response.
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Affiliation(s)
- Sarah W. Feldstein Ewing
- University Honors/University of New Mexico Center on Alcohol and Substance Abuse Addictions (UNM CASAA), 1 University of New Mexico, MSC06 3890, Albuquerque, NM 87131, USA
,Corresponding author telephone: +1-505-277-4211, fax: +1-505-277-4271,
| | - Hilary K. Mead
- Seattle Children’s Hospital, Psychiatry and Behavioral Medicine, 4800 Sand Point Way NE Seattle, WA, 98105, USA
| | | | - Sam DeWitt
- Center for Brain Health, School of Behavioral and Brain Sciences, The University of Texas at Dallas, 2200 West Mockingbird Lane, Dallas, TX 75235, USA
| | - Kent E. Hutchison
- The University of Colorado at Boulder, Department of Psychology and Neuroscience, Muenzinger D244, 345 UCB, Boulder, CO 80309-0345 USA
| | - Francesca M. Filbey
- Center for Brain Health, School of Behavioral and Brain Sciences, The University of Texas at Dallas, 2200 West Mockingbird Lane, Dallas, TX 75235, USA
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